Women's outcomes and experience of care

Summary

The objective is to describe the outcomes and diversity of experience of women receiving maternity care and to identify factors associated with having positive and less satisfactory experiences of pregnancy, childbirth and the postnatal period. Poor outcomes after childbirth have commonly been associated with physical ill health, however the role of other factors requires exploration. Thus the aim of the first study was to estimate the effects of a range of clinical and care factors on positive outcome and well-being three months after childbirth. National surveys carried out in 2006 and 2010 have enabled studies to identify key individual and experiential factors contributing to different outcomes for women after childbirth. Using the data on more than 5,000 women from the 2010 National Maternity Survey the study looked at the factors associated with being well three months after childbirth.

Key findings

• In the univariate analysis, several variables were significantly associated with positive outcome, including sociodemographic, antenatal, intrapartum, and postnatal factors.
• In the final logistic regression model, young mothers, those without physical disability and those with none or few antenatal or early postnatal problems, were most likely to have positive outcomes.
• Other factors contributing included a positive initial reaction to the pregnancy, not reporting antenatal depression, experiencing fewer worries about the labor and birth, and access to information about choices for care were also associated with a positive outcome.

In summary positive outcomes for women after childbirth may be influenced by health, social, and care factors. Holding in mind the negative factors extra support could be targeted at those women likely to be susceptible to poor outcome. Previous work has indicated that Black and Minority Ethnic women have a poorer pregnancy outcomes and poorer experience of maternity care than White women. Concern about these more negative experiences led to a study using the Care Quality Commission 2010 survey data and comparing the experience of care of those women from eight different ethnic groups. A total of 24,319 women completed the survey. Ethnicity was grouped into eight categories: White, Mixed, Indian, Pakistani, Bangladeshi, Black Caribbean, Black African, and Other ethnicity.

Key findings

• Compared to White women, women from BME groups were more likely to be younger, multiparous and without a partner.
• They tended to access antenatal care later in pregnancy, have fewer antenatal checks, fewer ultrasound scans and less screening.
• They were less likely to receive pain relief in labour and, Black African women in particular, were more likely to deliver by emergency caesarean section.
• Postnatally, women from minority ethnic groups had longer lengths of hospital stay and were more likely to breastfeed but they had fewer home visits from midwives.
• Throughout their maternity care, in this nationally representative sample, women from minority ethnic groups were less likely to feel spoken to so they could understand, to be treated with kindness, to be sufficiently involved in decisions and to have confidence and trust in the staff providing their care.

In summary, while there were some differences between the Asian groups and the Black African and Black Caribbean groups, women in all minority ethnic groups had a poorer experience of maternity services than White women, a finding which supports those of earlier studies in this area. In order to better understand some of the processes and factors at work in minority women's experience of care a qualitative study was also undertaken using the open text data from women participating in the 2006 National Maternity Survey. The data from 219 Black and minority Ethnic women were analysed thematically.

Key findings

• A major theme that emerged related to ‘feeling cared for,’ with sub-themes of ‘expectations of care’ and ‘policies, rules and organisational pressures’.
• Another involved ‘staff attitudes and communication’ with sub-themes of ‘please believe me,’ ‘hospital as a safe place,’ ‘choices denied’ and ‘being sensitive and supportive would help’.
• The theme of 'Ethnicity and culture’ was also evident with sub-themes of ‘stereotyping’ and ‘improving the quality of care.’

It was concluded that while many of the issues highlighted were not unique to BME women, the findings reflect some enduring issues and are coherent with other non UK findings, particularly in relation to post-natal care and staff attitudes. The failures of care provision described should inform the development of services.

Publications

Journal Articles

• Redshaw M, Henderson J. Learning the Hard Way: Expectations and Experiences of Infant Feeding Support. Birth. 2012;39(1):21-9.
• Jomeen J, Redshaw M. Ethnic minority women's experience of maternity services in England. Ethn Health. 2012;18(3):280-96.
• Rowlands IJ, Redshaw M. Mode of birth and women's psychological and physical wellbeing in the postnatal period. BMC Pregnancy Childbirth. 2012;12:138.
• Henderson J, Redshaw M. Who is well after childbirth? Factors related to positive outcome. Birth. 2013;40(1):1-9.
• Redshaw M, Henderson J. Fathers' engagement in pregnancy and childbirth: evidence from a national survey. BMC Pregnancy Childbirth. 2013;13(1):70.
• Redshaw M, Henderson J. From antenatal to postnatal depression: associated factors and mitigating influences. J Women's Health (Larchmt). 2013;22(6):518-25.
• Henderson J, Redshaw M. Women's experience of induction of labor: a mixed methods study. Acta Obstet Gynecol Scand. 2013;92(10):1159-67.
• Henderson J, Gao H, Redshaw M. Experiencing maternity care: the care received and perceptions of women from different ethnic groups. BMC Pregnancy Childbirth. 2013;13:196.
• Henderson J, Redshaw M. Anxiety in the perinatal period: antenatal and postnatal influences and women's experience of care. J Reprod Infant Psychol. 2013;31(5):465-78.
• Redshaw M, Miller YD, Hennegan J. Young women's experiences as consumers of maternity care in Queensland. Birth. 2014;41(1):56-63.
• Knight M, Lewis G, Acosta CD, Kurinczuk JJ. Maternal near-miss case reviews: the UK approach. BJOG. 2014 121 Suppl 4(Suppl 4):112-6.

Reports

• Fiona Alderdice, Karen Hamilton, Jenny McNeill, Fiona Lynn, Curran R, Redshaw M. Birth NI: A survey of women's experience of maternity care in Northern Ireland. Belfast: School of Nursing and Midwifery, Queen?s University Belfast. 2016.